A Systematic Review of the Endoscopic Management of Orbital Floor Fractures

OBJECTIVE: To determine the safety and efficacy of the endoscopic management of isolated orbital floor fractures. METHODS: A systematic review was performed using electronic databases. Studies investigating the reconstruction of isolated orbital floor fractures using an endoscopic approach were considered for inclusion. Two investigators independently reviewed all results. Study quality was assessed using the Methodological Index for Nonrandomized Studies scale. Primary outcomes were the resolution of diplopia and enophthalmos. Secondary outcomes were postoperative complications, including blindness, paresthesias, sinusitis, infection, conversion to external approach, and need for revision surgery. RESULTS: Nine studies capturing 172 patients met the inclusion criteria for systematic review. Two studies were comparative and 7 were case series. Study quality was poor, lacking prospective data and reliable assessment of outcomes. Strong reviewer agreement was observed (intraclass correlation, 84%; 95% CI, 35%-96%). Diplopia resolved in 102 of 118 patients (86%) and enophthalmos resolved in 41 of 43 (95%). No complications of blindness, sinusitis, or conversion to external approach were reported. Thirteen patients (8%) had transient cheek numbness. Two patients (1%) required revision surgery. CONCLUSIONS: Reconstruction of isolated orbital floor fractures through an endoscopic approach appears to be safe and effective. High-level evidence prospectively comparing endoscopic and external approaches, however, is lacking.